HB 712-FN - AS INTRODUCED
2025 SESSION
25-0438
05/09
HOUSE BILL 712-FN
AN ACT limiting breast surgeries for minors.
SPONSORS: Rep. Mazur, Hills. 44; Rep. Kofalt, Hills. 32; Rep. Reinfurt, Hills. 29; Rep. Seidel, Hills. 29; Rep. DeVito, Rock. 8; Rep. Litchfield, Rock. 32; Rep. Notter, Hills. 12; Rep. Noble, Hills. 2; Rep. Colcombe, Hills. 30; Rep. Layon, Rock. 13; Sen. Murphy, Dist 16; Sen. Sullivan, Dist 18
COMMITTEE: Health, Human Services and Elderly Affairs
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ANALYSIS
This bill limits breast surgeries for minors and provides a private right of action against the surgeon for violation of the statute.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
25-0438
05/09
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Five
AN ACT limiting breast surgeries for minors.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Subdivision; Limitations on Breast Surgeries for Minors. Amend RSA 329 by inserting after section 50 the following new subdivision:
Limitations on Breast Surgeries for Minors
329:51 Limitations on Breast Surgery for Minors. This subdivision is intended to limit permissible breast surgeries on people under the age of 18 to only those procedures needed to treat malignancy, injury, infection, or malformation and those needed to reconstruct the breasts after such procedures.
329:52 Definitions. In this subdivision:
I. “Abnormal development” means:
(a) “Gynecomastia” which is the abnormal development of breast tissue in biologic males;
(b) “Macromastia” which is excessive development of breast tissue in biologic females and includes juvenile hypertrophy of the breast and gigantomastia; or
(c) “Symptomatic macromastia” is macromastia which causes pain, deformity and/or recurrent skin infection.
II. “Breast surgery” includes:
(a) “Mammaplasty” which means surgery to reshape or reside the breasts by removing or transplanting tissue or inserting implants;
(b) “Mastectomy” which means surgery to remove all breast tissue; and/or
(c) “Mastopexy” which means surgery to lift the breast.
III. "Malignant" means cancerous or otherwise dangerous to the physical health of the person including physiology compromised by infection, lack of blood flow, or physical injury.
VI. “Margin” means the healthy tissue removed around malignant tissue to ensure that all malignancy has been removed, and any additional tissue as recommended by relevant medical guidelines.
VI. “Transgender chest surgery” means surgery to remove the breasts of a biologic female through mastectomy or to increase the size of breasts of a biologic male through augmentation mammaplasty.
329:53 Prohibitions and Enforcement.
I. Pursuant to this subdivision and RSA 332-M, no physician shall perform transgender chest surgery on a person under 18 years of age.
II. No physician shall perform breast surgery on a person under 18 years of age unless one or more of the following conditions are met:
(a) The procedure is subsequent to a diagnosis of cancer which necessitates such a procedure as part of a treatment plan;
(b) The procedure is needed to remove malignant tissue and an appropriate margin;
(c) Reconstruction of breast tissue to restore the breasts after injury or infection which requires the removal of breast tissue to restore the physical health of the person;
(d) The procedure is needed to correct gynecomastia and symptomatic macromastia; or
(e) Treatment of congenital deformities of the breast and/or chest wall.
III. A violation of this subdivision is unprofessional conduct and is subject to discipline by the board of medicine and/or the office of professional licensure and certification.
IV. Any person aggrieved by violation of this subdivision may initiate an action against the surgeon and may recover court costs and reasonable attorney’s fees as the prevailing party. Nothing in this section shall supersede or replace existing rights or remedies under any other law.
2 Title Change. Amend the title of RSA 332-M to read as follows:
CHAPTER 332-M
PROHIBITING [GENITAL] GENDER [REASSIGNMENT] SURGERY ON MINORS
3 Definition of Gender Reassignment Surgery Added. Amend RSA 332-M:2 by inserting after paragraph III the following new paragraph:
III-a. "Gender surgery" includes genital gender reassignment surgery, transgender chest surgery as defined in RSA 329:53, X, facial feminization or masculinization surgery, and/or removal of the reproductive organs for the purposes of gender identity including hysterectomy, oophorectomy, salpingo-oorphorectomy, and/or orchiectomy.
4 Prohibition of Gender Surgery on Minors. Amend RSA 332-M:3 to read as follows:
332-M:3 Prohibition of [Genital] Gender [Reassignment] Surgery on Minors.
I. A physician shall not perform [genital] gender [reassignment] surgery on minors in the state of New Hampshire.
II. Physicians are not prohibited from performing:
(a) Reconstructive surgeries on [the genitalia of] minors to correct malformation, malignancy, injury or physical disease;
(b) Removal of malignant, malformed, or otherwise damaged [genitalia] tissue;
(c) Genital surgeries on minors with disorders of sex development; or
(d) Male circumcision; or
(e) Breast surgery subject to the conditions of RSA 329:54, II(a)-(f).
5 Enforcement. Amend RSA 332-M:4, I to read as follows:
I. Any referral for or provision of [genital] gender [reassignment] surgery to an individual under 18 years of age is unprofessional conduct and is subject to discipline by the appropriate licensing entity or disciplinary review board with competent jurisdiction in this state.
I. Section 1 of this act shall take effect 60 days after its passage.
II. The remainder of this act shall take effect January 1, 2026.
25-0438
Revised 1/28/25
HB 712-FN- FISCAL NOTE
AS INTRODUCED
AN ACT limiting breast surgeries for minors.
FISCAL IMPACT: This bill does not provide funding, nor does it authorize new positions.
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Estimated State Impact | ||||||
| FY 2025 | FY 2026 | FY 2027 | FY 2028 | ||
Revenue | $0 | $0 | $0 | $0 | ||
Revenue Fund(s) | None | |||||
Expenditures* | $0 | Indeterminable Increase more than $10,000 to $100,000 or less per fiscal year | ||||
Funding Source(s) | General Fund | |||||
Appropriations* | $0 | $0 | $0 | $0 | ||
Funding Source(s) | None | |||||
*Expenditure = Cost of bill *Appropriation = Authorized funding to cover cost of bill | ||||||
METHODOLOGY:
This bill places limitations on permissible breast surgeries on people under the age of 18 to only those procedures needed to treat malignancy, injury, infection, or malformation and those needed to reconstruct the breasts after such procedures.
The Department of Health and Human Services (DHHS) states this bill could lead to an uncertain increase in General Fund expenditures, given that gender surgery for individuals under 19 is an extremely rare occurrence. Furthermore, DHHS suggests that the bill might result in minimal, if any, savings to Medicaid expenditures, as prohibiting breast surgery for minors could lead to the substitution of other services, potentially offsetting or exceeding any anticipated savings. The indeterminable increase in expenditures is anticipated to be more than $10,000 to $100,000 or less.
The Department of Justice (DOJ) states that the bill incorporates prohibitions in RSA 332-M which includes a provision to authorize the Attorney General to bring legal action to enforce the law, as well as other private rights actions. However, the fiscal impact is likely to be under $10,000 although it is indeterminable as the amount of cases is unknown. Additionally, the DOJ could potentially be involved in any complaints of unprofessional conduct to the Office of Professional Licensure and Certification for legal guidance.
The Judicial Branch indicates that this bill would result in an increase of litigation under $10,000.
This could possibly result in an increase in civil cases in the Superior Court, however, there is no way to predict how many such actions would occur so any such increase is indeterminable. The Judicial Branch has provided average cost information for civil cases in the Superior Court:
NH Judicial Branch Average Civil Case Estimates
Judicial Branch Average Cost | FY 2025 | FY 2026 |
Superior Court Complex Civil Case | $1,430 | $1,473 |
Superior Court Routine Civil Case | $535 | $552 |
Common Civil Case Fees
Superior Court Fees | As of 2/12/2020 |
Original Entry Fee | $280 |
Third-Party Claim | $280 |
Motion to Reopen | $160 |
It is assumed that any fiscal impact would occur after FY 2025.
AGENCIES CONTACTED:
Department of Health and Human Services, Department of Justice, and Judicial Branch
| Date | Amendment |
|---|---|
| March 11, 2025 | 2025-0933h |
| Date | Body | Type |
|---|---|---|
| March 3, 2025 | House | Hearing |
Feb. 25, 2025: Public Hearing: 03/03/2025 01:00 pm LOB 306-308
Jan. 22, 2025: Introduced (in recess of) 01/09/2025 and referred to Health, Human Services and Elderly Affairs HJ 3 P. 24